Objective
Single-pill combination (SPC) therapy is recommended as first-line therapy for most
patients in global hypertension guidelines due to benefits of improved adherence and
blood pressure (BP) control. We aimed to understand factors affecting SPC use in the
management of raised BP in Australia.
Design
A mixed-method study comprising of qualitative (policy review and interviews) and
quantitative (Pharmaceutical Benefits Scheme [PBS] data) approaches.
Main Outcome Measures
Australian and international hypertension guideline recommendations regarding SPC
use; the Australian registration and subsidy approval processes of SPCs; use of SPCs
on the PBS; cost-analysis of PBS-listed SPCs compared to free-drug combinations; perceptions
of healthcare providers towards SPCs.
Results
The 2016 Australian Heart Foundation’s “Guideline for the diagnosis and management
of hypertension in adults” does not recommend combination therapy (including SPCs)
as first-line treatment. Additional challenges in the uptake of SPCs include: (1)
the additional PBS requirements and barriers imposed for the listing of SPCs. (2)
Script volumes for SPCs have not matched the rise in the number of SPCs listed for
subsidy, have plateaued since 2016 and remained significantly lower than single constituent
scripts. (3) SPCs are not subsidised by the PBS for initial treatment. Most SPCs provided
substantial cost savings for individual patients compared to free-drug combinations.
Health care providers were positive about the cost-saving and convenience of SPCs,
however perceived negatives included inflexibility of SPCs during dose titration,
medicine shortages, and potential adverse effects when initiating treatment with multiple
drugs.
Conclusion
The safety, efficacy and cost-saving potential of SPCs have been established in the
literature but several roadblocks in the existing health system in Australia impede
uptake. Interventions addressing these barriers may facilitate improved uptake, which
may in turn improve blood pressure control in Australia.
Keywords
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Article info
Publication history
Published online: February 24, 2022
Accepted:
January 22,
2022
Received in revised form:
January 19,
2022
Received:
October 29,
2021
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
